Best hospital in Melbourne for a chance at VBAC???

[RoyaUK]

I just had my second DD last week at the Royal Womens and found the midwives and obs on duty during labour very supportive of VBAC. Unfortunately, my body didn't want to play ball and i ended up with another emergency c-section, but it was certainly not due to any pressure from the medical team.

[Beach Mama]

Oh thanks so much Cai! I'm crying about this AGAIN because I just HATE the fact that I am classed as high risk, I hate the fact that I am a chicken and DH is scared to home birth too, and I just don't know what my best option is.

Birralee is Box Hill Cai sorry, that's what their maternity ward is called. When I had my over the phone triage with a midwife the other day she basically said, yes we midwives will support you wholeheartedly, but majority of the doctors will not. They will try to book in my c/s at my first appointment at 15 weeks so if I decide to go there you can bet I will be going in with all my studies and research on hand to shove in their narrow minded surgery focused puny brains.

Cai is there any hospital in Melbourne you would recommend I try to look at or do you think I should just arm myself with great people and research like you said and brave Box Hill or the Mercy? It really sounds like unless I move to Warrigul my options are limited.

I've also been thinking about seeing a pro-VBAC ob - thats going to take a bit of convincing for DH though, but the doula is a done deal - now just to choose from my fabulous options here!!

Ugh I'm so glad I have a bit of time to decide!
Thanks again for all your advice everyone!!

[Olive]

tan did you check out Peter Lee???

[Beach Mama]

Hey AJP - he works from the Angliss and the Angliss is off my list right now. I'm still to visit Monash and the Mercy, so it will be between them and Box Hill.

[Janie]

Tan, just wanting to wish you well, I'm sure you'll make the best decision, guided by knowledgeable ladies here on BB I can't wait to follow your journey. You can do it hun!!!!!!

[Julie Doula]

Tanstar - there are a few Obs who are supportive of VBAC. David Simon at Warragul is one of them. I know that's too far for you. I'm another one who is leery of Box Hill from what I've seen my clients have to deal with there. If you're sold on going to hospital for your VBAC, seriously consider hiring a private midwife or doula. What about hiring a midwife for a homebirth? I heard Helen Brown of Midwives Naturally give a talk on VBAC - the homebirth stats for VBAC are the best in Victoria. It might seem like a scary option, but these midwives are truly pros and it could end up being less scary than being in hospital.

All the best for your decisions and a wonderful birth in the end.

[KatieKoo]

Hi, at the very least see if you can take an independant midwife with you.
I've also heard that the KYM program at Box Hill has gone downhill, don't know if they'd take you cause you're a VBAC (they couldn't take me cause I'm trying for twin VBAC). I also know of someone who was going for VBAC there and was harrassed to be induced for being overdue (refused) and had her VBAC, albeit giving birth on a guerney on the way to theatre for another ceasar with head coming out - did not sound supported at all!

My sister had a successful VBAC at Monash Clayton and was very supported/encouraged through her anti natal care (the midwife with her in labour had had a VBAC herself).
A friend also had a VBAC at the Mercy, but took an independant midwife with her.

I had my second anti natal appt at Monash Clayton yesterday with an Ob which I very positive and encouraging having spoken of my wish to have my twin VBAC there (it's nice and close, we live in Clayton), however I'm also going to see David Simon at Warragul for more information/gauge support.

The important thing to remember is you have choice and you have to give consent to anything being done to you. Do your research and be well informed before meeting with hospitals, it really helps. The risk of uterine rupture is .35% (less than 1%) so very low.

Have you thought about a homebirth?

Good luck with it and stay strong to your wishes. I understand the fear of not being able to do it, but you can and lots of people do everyday.

Best wishes,
KT.

[leanne30]

not sure if this is too late, but i wanted to quickly share my thoughts....

i believe it's the OB/midwife you get that will help you to have the VBAC, rather than the hospital.

I can fully recommend Dr Guy Skinner (based in Fitzroy) - he was brilliant. i had an emergency c/s with my first baby (induced, then failed to progress). i fully believe i ended up with the c/s based on the OB who was caesar happy. needless to say, i dumped her with my 2nd child and went with Guy as i found out he had a great reputation for VBACs.

and on the 1st march this year, i had a successful VBAC at Frances Perry (Royal Womens)! it was very long (1.5 days of labour) and i had lots of drugs to help, but never at any stage (or during the course of pregnancy) did Guy talk about a c/s.

if you can find a pro-VBAC OB, that would be my recommendation.

as for getting through it without too much stress, i found that i was far too busy concentrating on the pain to worry about a c/s! i actually dont think it crossed my mind the whole time. it was just wonderful to know my body was doing was it was supposed to do - no drugs forcing it to do anythign it wasnt ready for.

PS they now have telemetric monitors (no wires) so your baby can be monitored while you walk around the room, or even have a bath! they are waterproof too. you dont have to be strapped to the bed. i know Frances Perry have them (they are new and quite expensive i think), not sure of other hospitals.

[Julie Doula]

Here is some interesting info on another way to approach VBAC, by staying at home and having the midwife come to you. This is an alternative some women choose who desire a low-tech approach to birth, since birth centre policy in Victoria means that women are not accepted for VBAC at birth centres.

Helen Brown’s “VBAC Recipe”

Helen Brown is a midwife working at the Angliss Hospital and attending homebirths.

As presented at the Kallista Birth Week, November 2007

Midwives specialize in keeping birth normal – if possible, preventing the primary c/s.

Many things told to women are not based on fact, but are actually opinion.

Helen has attended several VBA2C at home. One woman faced a lot of negativity. Her baby’s head was 38 cm (fairly large) and she took 15 mins to push her baby out. You can stand strong in the face of negativity.

The Recipe:

1. Own Choice of Primary Caregiver – one who believes that you’re capable. Care is centered around vaginal birth and the caregiver has a high normal birth rate. Does not practice “Just In Case Obstetrics”.

2. Own Choice of Birth Place

3. A Belief that Your Body is Capable of Vaginal Birth

4. 100% Commitment to VBAC

5. Partner Supportive of VBAC - He may not be on the same page as you, or exactly where you are at, but he needs to be supportive of your choice, and of your right to assert your choice, even if he has his own reservations at this stage in his journey of discovery.

6. Extra Birth Support – a friend or relative who believes in birth, VBAC and YOU and will not be spooked by the effort and process of birth. A trained Doula (birth attendant) can be more objective, is paid by you to be in your corner and to be at your service no matter what. Is able to remind you of your choices, your birth plan preferences and any alternatives there may be.

7. Practice Optimal Foetal Positioning – daily from 30 weeks, to encourage baby to lie in an anterior (front-lying) position. Hands & knees or elbows and knees, for 20 – 3- mins twice daily. As soon as you wake up and just before sleeping is a good time to do it. And while watching TV. Avoid reclining backwards (like we normally do when sitting on a sofa).

8. Increase Level of Physical Fitness – if your lifestyle is normally quite sedentary. Regular exercise helps your body to work efficiently. Walk for half an hour per day absolute minimum. Better yet, regular exercise (walking & swimming are ideal) for an hour per day.

9. Prepare for Birth
- understanding of what is involved in birth
- at night – stay in bed, sleep or doze between contractions
- Strategies for Pre-Labour: - keep eating & drinking – avoid dehydration – eat complex carbs like athletes do – keep moving – don’t pay too much attention to early contractions
- Labour is a muscular activity
- Practice relaxation & breathing
- Calmbirthing
- Childbirth Education classes
- Visualisations and affirmations – combat doubts & fears in your mind, speak out the positive
- pelvic adjustment with Chiropractor who understands the Webster Technique
- Deal with emotional / social / psychological issues,emotional stuff from the past,trauma, relationship issues.
- Be prepared for ‘wild card’ crises of confidence

10. Spontaneous Onset of Labour

11. No Interventions to Physiological Process. Avoid vaginal exams, which undermine your confidence.

12. No Restrictions – on your physicality, time, food & fluids. No IV, able to walk around.

13. No Continuous CTG (foetal heart monitor) - Say no to CEFM. (Continuous Electrical Foetal Monitoring). Have a document in your notes stating that you decline CEFM. Use strong language: “I do not give my permission for CEFM and I take responsibility for this.”
CEFM leads to caesarian.

14. Have your doula come to your home, and stay at home until the last possible minute.

The hospital is a fear-based system. Surround yourself with positivity. Do not let your options be pushed aside.

Many women make the same choices and get the same outcome. If you want a different outcome, make different choices.

You have to want it, believe that you can. De-brief fully from the first experience. This will take time, and counseling may help.

Reasons for the Primary Caesarian – this is a pattern we commonly see:
- overdue
- induced
- a long posterior labour
- membranes ruptured first (common in overdue pregnancy with baby in posterior position)
- go to hospital too soon
- still only in pre-labour – but NOT sent home by the hospital
- waters broken and augmentation (syntocinon) given
- cascade of interventions
- if you are induced you are 60% more likely to have a c/s
- if you have an epidural it increases the likelihood that you will have a c/s (Check Cochrane and PubMed for research).

Of women in Australia who had a primary c/s, only 28% are given an opportunity to try for a VBAC. 72% have repeat c/s. Of the 28% who try for VBAC, 58% succeed in the hospital system.

Midwives Naturally have nearly a 90% success rate so far for VBAC at home. Of 15 women who tried for VBAC at home with Midwives Naturally, 13 achieved VBAC and 2 required a repeat c/s, one for an emergency prior to labour starting, and one due to problems in second stage.

Homebirths Australia-wide have an 8% c/s rate compared to a nearly 40% c/s rate nationally.

Midwives Naturally have a 11% transfer rate. This means that out of all planned homebirths, 11% result in transfer to hospital for some reason – before, during or after birth. The homebirth transfer rate nationally is 19%. This is a lower transfer rate than most birth centres, who due to stringent policies laid down by obstetricians, have a transfer rate of around 40%.

[Beach Mama]

Fantastic info Julie! Thank you so much! I really would love a home birth, but DH is against it, and I'm only just learning to trust myself and my body so it will be out for us.

I am booked at the Mercy in Heidleberg and I am having a doula. We are ging to meet with a few on our list in a few weeks time.

Use strong language: “I do not give my permission for CEFM and I take responsibility for this.”
CEFM leads to caesarian.

Can you tell me why this leads to c/s????? I have no probs with telling them I don't want it, I'd just like to know the reason why??!!

[krisp]

I had my DD in November at Monash but with a private OB. I couldn't birth at the "birthing centre" because I was considered high risk (what rubbish!) but at Monash the labour and delivey suites are the same for both public and private pataients and then you either go to the public ward or across the corridoor to Jessie Mac PH. The midwives and my Doc were fabulous and I got my vaginal birth, it was had work but soooo worth it!

[BellyBelly]

KatieKoo, I have heard that about Box Hill sooooo many times now. I think they were/are trying to shut down KYM but I am not sure... but I do know too many women who have been badgered about VBACs, twins and other things and ironically they use the same excuse.... along the lines of, 'You'd be crazy not to take this date for a c/s/induction, we have a great surgeon on, if you need it any other day you might get a registrar.... etc etc etc.' I'd avoid it like the plague.

I'm just saddened to think about how many women agree to it not knowing better.

[Julie Doula]

Can you tell me why CEFM leads to c/s????? I have no probs with telling them I don't want it, I'd just like to know the reason why??!!

Hi Tanstar, that's a good question. I don't think Helen meant that Continuous Electrical Foetal Monitoring definitely leads to c/s (these are just my notes of her talk) but what she meant is that it IS a pattern they see a lot of. My understanding is that when you have the continuous monitoring, it does impact your freedom of movement and ability to get gravity working to your advantage that is so essential for physiological birth.

Often women are persuaded to consent to CEFM by being told that "this is a mobile mponitor, you'll still be able to move around", or "the leads are quite long, you'll still be able to stand and move beside the bed so you can still use gravity." But it does not work out so well in practice. You are still tethered, it still inhibits your ability to move freely and instinctively. Many women find it inhibiting to have the belt around the part of their body that is trying to work so powerfully. Also, too many times I have seen that the machine does not work right and does not pick up a good trace unless the woman remains very still. The focus in the room shifts from helping the WOMAN's BODY to work right - to making sure the machine is working right. Too much watching of the machine and not enough watching of, and listening to, the woman.

One of my clients was busy pacing from one foot to the other with the hot shower on her back, when the midwife at Box Hell (er, sorry - Box Hill) burst in and said, "You'd think out of all the pairs of hands down there, at least ONE of you could keep a hand on the monitor!" We had to hold it in place so the thing would work. We wanted to be holding the shower on her and rubbing her sacrum. The midwife later said to me, "If the Obstetrician could see that, he'd send her STRAIGHT upstairs for a ceasarean!" I was startled, I couldn't help but think, why would you 'send' a woman for a c/s, just because the machine doesn't work right?" It is not the woman's body that is faulty, it is the technology, which is ill-conceived in the first place.

Another of my clients, (whose actual birth I unfortunately missed due to its being precipitate) ended up on the bed with CEFM - just what she didn't want. She began to feel quite uncomfortable. The midwife said the monitor was showing that she was only having gentle early labour contractions. My client began to writhe, thinking I an't believe this is just early labour. The senior midwife told her, "Well how do you think you'll cope with a long labour then?" and to her assistant said, within my client's hearing, "We're not coping very well." My client was not in early labour, she was in active labour and had the baby 2 hours later. Another example of when the machine was credited over the mother, whose perspective was ignored. The machine was wrong. The mother was right. The wise watchword, "Listen To The Mother" was ignored in favour of the technology.

The technology, with bells, lights and whistles, gives the impression of being scientific, when in fact, science shows quite the opposite - scientifically speaking, CEFM hinders the release of the birth hormones as thus is counterproductive to a safe, progressing birth.

It is another example of birth technology that should not be used routinely, or as a cheap alternative to one-to-one pesonalized care, but only in rare and needful situations, with a full understanding of the detrimental effects it may cause.

The Birthrites and ICAN websites are helpful sources of info for women wishing to decline CEFM and studies to back it up.

Here's some notes on CEFM that a midwife shared with me:

Continuous Foetal Monitoring
The CTG monitor can be over-used and findings are often insignificant.

Although the CTG monitor has high sensitivity in predicting the normal foetus, the foetal monitor is not able to accurately and consistently predict a sick newborn. 1
- Cabaniss, 1993 p. 19

The benefits of foetal monitoring are modest and resulted in prolonged labours. Gains are achieved at the cost of a higher rate of caesarean section and operative vaginal delivery. 2
- Stroup and Peterson (1996 p.317)

The only significant effect of continuous electronic foetal monitoring was an increase in the caesarean rate. 3
- Odent (1996)

References:

1. Cabaniss, M.L. 1992. Fetal Monitoring Interpretation. J.13 Lippincott, Philadelphia.

2. Stroup, T.S. and Peterson, H.B. 1996. Routine intraparturn electronic fetal monitoring decreases neonatal seizures but increases operative deliveries. MIDIRS Midwifery Digest. 6(3).

3. Odent, M. 1996. Kitting needles, cameras and electronic fetal monitor. MIDIRS Midwifery Digest. 6(3).

[Beach Mama]

Thank you so much for the info Julie, I am going to be printing off so many of these pages to take with me to my appointments at the Mercy!

Just for other people's info too, I had my booking appointment with a midwife at BH, over the phone, as I initially had booked with them while checking out other places. Anyway, I explained about my strong desire for a VBAC and that I wanted support and was going to have a doula etc. I was honest and said that I had heard they aren't very supportive or say they are but then aren't on the day and she basically told me that all of the midwives would be supportive of it, however every Dr wouldn't be and they would try to book me in for a c/s at each and every appointment and on the day of the birth. NO THANKS!!!

Thanks again everyone!

[Janie]

Go Tan! Oh hun, I know you're going to do so well

FWIW, our niece had her first bub at the Mercy last year, and she had a wonderful vaginal birth. She said the midwives were awesome!

[didispunk]

I might join in on the lovely!! wanting a VBAC..

I would like to know.. what is normal? How many Days overdue will they let you go? c
Can you use the drip
What happens if you dont go into labour on your own? Will they induce at all?
Can I say no?
Can i get in the bath?
What % do i have of succesful VBAC..
I had BAD preaclampsia with DS.. and this time no sign of it so far.. early i know.. But am exercising and eating very well!!!

I NEED HELP!!!!! i know 20 weeks to go.. but it does fly!

[Beach Mama]

Hey Didispunk!! Welcome and good luck for your VBAC!!! I will answer these questions best as I can from the reading I have done so far!!! We are due a couple of weeks apart - do you know which hospital you are going to??

I would like to know.. what is normal? How many Days overdue will they let you go? I think it depends on the hospital - some are keen to book in a c/s on your due date- others will let you wait and see- definately speak to your carers about the hospital policy on this one.
Can you use the dripDo you mean the syntocin/induction drip? In that case the answer would be no as there is a much higher chance of your scar rupturing if you are medically induced.
What happens if you dont go into labour on your own? Will they induce at all?They may try things like the gel (I think) or a stretch and sweep but not a medical induction with synto.
Can I say no?It is always your choice hun, and it is your body so yes you can, but you want to ave strong support people around you and it is good to let your carers know your birt intentions from the beginning - write a birth plan covering everything to go through with them!
Can i get in the bath?Depends on the hospital - most will want you to have continuous fetal monitoring, at my last hospital when I was induced I was able to use mobile monitoring and use the bath but not all places have them
What % do i have of succesful VBAC.. Im not sure what the % are plus Im not sure if you develop PE again what will happen - again your hospital will be able to answer better than me.

I recommend you speak to them about all of the questions that you have and find a hospital that will support you. I changed from BH to Mercy for this reason and have found them to be fabulous so far.

Good luck with it all and ask any questions you like! Hopefully if Im wrong about any of this someone will pop in and set me straight!

[didispunk]

Thanks Tan so so very much!! that is brilliant!!! thank you very very much!!

I am going in June to doc again.. i will then ask questions. i just feel that they are so very very fast with my appointments kinda saying in the back of their minds.. "YOU have 20 weeks plenty of time"

I am going to canada in july till end of Aug.. so really not tha much time!!!